Vitassium Club - Registration Form Europe
Only for people residing in Europe. The Vitassium Club is only for people with dysautonomia, POTS or EDS who use SaltStick as a medical food. If this applies to you, a child, or loved one you are caring for, we encourage you to join the Vitassium Club today.

To become a member of the Vitassium club, you need to complete this Vitassium membership application.

Go to Vitassium.com to learn more about Vitassium.

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Email *
Your name (first and last name) *
What's your street and house number? *
Additional address details - if necessary?
What is your zip code and city? *
Which Country do you live in? *
Who do you buy SaltStick/Vitassium products for? *
Is the person taking Vitassium for dysautonomia, POTS, cystic fibrosis female or male?
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How old is the person taking Vitassium for dysautonomia?
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Did you find out about the Vitassium Club through one of the following channels: Facebook, Google, Dysautonomia International, the Ehlers-Danlos Society, your doctor, anywhere else?
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How did you find out about Vitassium or other SaltStick products? Please be as specific as possible.
Which SaltStick products do you use and how long have you been using them?
SaltStick/Vitassium works with doctors, clinics and self-help groups by providing free products for partners who work to educate and cure dysautonomia. Which doctor, clinic or self-help group do you recommend we contact?
Do you know anyone who would benefit from Vitassium? If so, please include their email address below so that we can send some information to these people.
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